Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter I - Specific Policies By Service
Sec2 144-101-I-1 - GENERAL ADMINISTRATIVE POLICIES AND PROCEDURES
Subsection 144-101-I-1.21 - REINSTATEMENT FROM TERMINATION OR EXCLUSION

Universal Citation: 10 ME Code Rules § 144-101-I-1.21

Current through 2024-38, September 18, 2024

A. Reinstatement Procedures from Termination or Exclusion

1. For reinstatement to occur, a request for reinstatement must be addressed to the Manager of Program Integrity in writing. Considerations for reinstatement include:

a. Any sanctions, including outstanding monetary sanctions;

b. Whether all fines and debts (including overpayments) due and owed to any federal, state or local government that relate to MaineCare, Medicare or any state health care program have been paid or whether satisfactory arrangements have been made to fulfill these obligations;

c. The conduct of the individual or entity prior to the date of the notice of the exclusion, including conduct not known to the agency at the time of the exclusion; and

d. The conduct of the individual or entity after the date of the notice of exclusion.

Any request for reinstatement will be reviewed in relation to any decisions or actions made by the United States Department of Health and Human Services, to past actions in MaineCare, and to other relevant factors such as professional sanctions.

2. Reinstatement after termination or exclusion may not be considered before one (1) year or the minimum period of time when stated below, whichever is greater, as calculated from the effective date of the termination or exclusion, unless a different time period is required consistent with federal law or rule. The following minimum periods of time apply:

a. Conviction of program-related crimes, five (5) years;

b. Conviction relating to patient abuse or neglect, five (5) years;

c. Felony conviction relating to health care fraud, five (5) years;

d. Conviction of two (2) of the above offenses, ten (10) years;

e. Conviction of three (3) of the above offenses, permanent exclusion;

f. Misdemeanor conviction relating to health care fraud, three (3) years;

g. License revocation or suspension, no less than period imposed by state licensing authority;

h. Exclusion or suspension under federal health care program, no less than the period imposed by federal health care program;

i. Individuals controlling a sanctioned entity, same period as entity; and j. Violation of the terms of an exclusion or termination:

i. Any month in which an excluded individual violates the terms of their exclusion or termination shall not be counted against the minimum period of time before reinstatement may be requested.

ii. The Department shall impose an additional period of exclusion or termination equal to one-half of the original minimum period after becoming aware of any violation. The additional period of exclusion or termination will commence upon written notification to the individual of the violation.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

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